More than 2 decades have passed since the 1990-1991 conflict in the Persian Gulf. During the intervening years, many Gulf War veterans have experienced various unexplained symptoms that many associate with service in the gulf region, but no specific exposure has been definitively associated with symptoms. Numerous researchers have described the pattern of signs and symptoms found in deployed Gulf War veterans and noted that they report unexplained symptoms at higher rates than nondeployed veterans or veterans deployed elsewhere during the same period. Gulf War veterans have consistently shown a higher level of morbidity than the nondeployed, in some cases with severe and debilitating consequences. However, efforts to define a unique illness or syndrome in Gulf War veterans have failed, as have attempts to develop a uniformly accepted case definition.

Chronic Multisymptom Illness in Gulf War Veterans is a comprehensive review of the available scientific and medical literature regarding symptoms for chronic multisymptom illness (CMI) among the 1991 Gulf War Veterans. This report evaluates and summarizes the literature in an effort to identify appropriate terminology to use in referring to CMI in Gulf War Veterans. While the report does not recommend one specific case definition over another, Chronic Multisymptom Illness in Gulf War Veterans does recommend the consideration of two case definitions on the basis of their concordance with the evidence and their ability to identify specific symptoms commonly reported by Gulf War veterans. This report recommends that the Department of Veterans Affairs use the term Gulf War illness rather than CMI. The report recommends that that the Department of Veterans Affairs, to the extent possible, systematically assess existing data to identify additional features of Gulf War illness, such as onset, duration, severity, frequency of symptoms, and exclusionary criteria to produce a more robust case definition.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE DEVELOPMENT OF A CONSENSUS CASE DEFINITION FOR CHRONIC MULTISYMPTOM ILLNESS IN 1990–1991 GULF WAR VETERANS
• Reviewers
• SUMMARY
  • BACKGROUND
  • ADDRESSING CHRONIC MULTISYMPTOM ILLNESS IN GULF WAR VETERANS
  • GULF WAR SYMPTOM STUDIES
  • THE USE OF FACTOR ANALYSIS IN STUDIES OF CHRONIC MULTISYMPTOM ILLNESS
  • DISCUSSION OF EXISTING CASE DEFINITIONS
  • RECOMMENDATIONS
  • REFERENCES
• 1. INTRODUCTION
  • BACKGROUND
  • THE GULF WAR SETTING
  • CHARGE TO THE COMMITTEE
  • HOW THE COMMITTEE APPROACHED ITS CHARGE
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. CASE DEFINITIONS
  • ADDRESSING CHRONIC MULTISYMPTOM ILLNESS IN GULF WAR VETERANS
  • DEVELOPING CASE DEFINITIONS
  • REFERENCES
• 3. STUDIES OF SYMPTOMS IN GULF WAR VETERANS
  • GENERAL LIMITATIONS OF GULF WAR STUDIES
  • POPULATION-BASED STUDIES
  • MILITARY-UNIT–BASED STUDIES
  • REGISTRY STUDIES
  • SUMMARY
  • REFERENCES
• 4. FACTOR ANALYSIS AND ITS USE IN STUDIES OF SYMPTOMS IN GULF WAR VETERANS
  • FACTOR ANALYSIS
  • FACTOR-ANALYSIS STUDIES
  • CLUSTER-ANALYSIS STUDIES
  • REFERENCES
• 5. CHRONIC MULTISYMPTOM ILLNESS CASE DEFINITIONS AND RECOMMENDATIONS
  • EXISTING CASE DEFINITIONS
  • DISCUSSION OF EXISTING CASE DEFINITIONS
  • RECOMMENDATIONS
  • CONSIDERATIONS FOR FUTURE RESEARCH
  • REFERENCES
• APPENDIXES
  • ADDITIONAL INFORMATION ABOUT FACTOR ANALYSIS AND CLUSTER ANALYSIS
  • PERCENTAGES OF VETERANS REPORTING SYMPTOMS IN STUDIES OF GULF WAR VETERANS AND MILITARY PERSONNEL

This study was supported by Contract VA240-13-D-0024 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.